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Nervous and mental Disease monograph Series No. n. 



The Theory of 
Schizophrenic Negativism 



BY 

PROFESSOR DR. E. BLEULER 

PROFESSOR OF PSVCHIATRY, UNIVERSITY OF ZURICH ; DIRECTOR OF BURGHOLZLl ASYLUM 

TRANSLATED BY 

WILLIAM A. WHITE, M.D. 

SUPBRINTKNDENT OF THE GOVERNMENT HOSPITAL FOR THE INSANE, WASHINGTON, D. C. 



NEW YORK 

The Journal of Nervous and Mental Disease 

Publishing Company 

1912 

Reprinted with the permission of the Original PubHsher 

JOHNSON REPRINT CORPORATION JOHNSON REPRINT COMPANY LTD. 
1 1 1 Fifth Avenue, New York, N.Y. 10003 Berkeley Square House, London, W1X6BA 



First reprinting 1970, Johnson Reprint Corporation 
Printed in the United States of America 



Copyright 1912 

BY 

The Journal of Nervous and Mental Disease 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM^ 



CONTENTS 



The theories of negativism that have been advanced hereto- 
fore are incorrect or unsatisfying. Negativism is a complicated 
symptom, having in some cases, many cooperating causes. 

The predisposing causes of negativistic phenomena are: 

1. Ambitendency, which sets free with every tendency a 
counter tendency. 

2. Ambivalency, which gives to the same idea two contrary 
feeling tones and invests the same thought simultaneously with 
both a positive and a negative character. 

3. The schizophrenic splitting of the psyche, which hinders 
the proper balancing of the opposing and cooperating psychisms, 
with the result that the most inappropriate impulse can be trans- 
ferred into action just as well as the right impulse and that in 
addition to the right thought, or instead of it, its negative can 
be thought. 

4. The lack of clearness and imperfect logic of the schiso- 
phrenic thoughts in general which makes a theoretical and prac- 
tical adaptation to reality difficult or impossible. 

On the ground of this disposition there may occur direct 
negativistic phenomena in such a manner that positive and neg- 
ative psychisms replace one another indiscriminately, only the 
incorrect reactions standing out as pathological negativism. 

* E. Bleuler, Zur Theorie des schizophrenen Negativismus, Psy- 
chiatrisch-Neurologische Wochenschrift, Vol. 12, 1910/11, Nr. 18, 19, 20, 2r. 



2 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

As a rule, however, the negativistic reaction does not appear 
merely as accidental, but as actually preferred to the correct re- 
action. 

In ordinary external negativism which consists in the nega- 
tion of external influences (Ex, Command) and of what one 
would normally expect the patient to do (Ex. Defaecation in 
the closet instead of the bed), the following causes are at work: 

(o) The autistic withdrawing of the patient into his phanta- 
sies, which makes every influence acting from without compara- 
tively an intolerable interruption. This appears to be the most 
important factor. In severe cases it alone is sufficient to produce 
negativism. 

(&) The existence of a hurt (negative complex, unfulfilled 
wish) which must be protected from contacts. 

(c) The misunderstanding of the surroundings and their pur- 
pose. 

{d) Direct hostile relations to the surroundings. 

{e) The pathological irritability of the schizophrenic. 

(/) The pressure of thought and other difficulties of action 
and of thought, through which every reaction becomes painful. 

{g) The sexuality with its ambivalent feeling tones is also 
often one of the roots of negativistic reaction. 

Inner negativism (contrary tendency opposed to the will, 
and intellectually opposed to the right thoughts) is accounted 
for, in large part, by ambitendency and ambivalency, which in 
view of the inner splitting of the thought renders intelligible a 
slight preference for the negativistic reaction. Very pronounced 
phenomena of inner negativism probably have other cooperating 
causes, which we, at the present time, do not know. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 3 

A conclusive explanation of all negativistic phenomena would 
be premature. It seems to me, however, that the falsity or 
unsatisfactory nature of the theories hitherto erected might be 
demonstrated. It is always possible to discover roots of nega- 
tivism in other directions and to understand genetically, at least, 
a part of the symptoms grouped together under this name. A 
better attitude is gained in this way for further progress. 

At this point we must first make clear that negativism is not 
a unitary symptom. The chief and predominating group is 
characterized throughout by the fact that the patient, by outside 
influences, by command, will not do precisely, what under normal 
conditions would be expected (passive negativism) ; or, that he 
does exactly the opposite (active negativism). A command is 
not executed, most often after a clearly repulsing mimik. If one 
tries to bring about a desired movement passively (raise the 
arm, sit up to slip on clothes) they show opposition, seek to get 
away, resist often with abuse and blows. The patients will not 
stand up, will not go to bed, if it is desired of them; they will 
not sit at the place assigned to them, will not eat the food offered 
them, they take the soup with the spoon for the preserves, and 
the preserves with the soup spoon; they satisfy natural needs out 
of time and place. From simple opposition to the active execu- 
tion of the opposite of what is expected there are all gradations. 

Not even this circumscribed group gives an impression of 
unity. Most patients indeed combine their negativistic actions 
with an affect of irritability, vexation, anger. This emotional 
reaction is, however, not a necessary component. If the nega- 
tivistic action is simply the contradiction of a custom, if it is 
not interfered with from without, the previous mood is usually 
maintained; the patient lies down, with apparent indifference, in 



4 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

the bed of his neighbor; in some cases one sees even a certain 
mirth over a successful trick. Repression first awakes irritability 
in these cases. 

Often the patients maintain their indifference in spite of 
opposition; it may be that very strongly negativistic patients 
are permanently euphoric and do not come out of this mood, 
while they resist with bites, scratches, and blows the invitation 
to shake hands; their defense is sport for them like a jolly play. 
More commonly the whole behavior looks like that of a flirt; 
women patients watch the physician, as if they were waiting for 
him to offer them his hand, or bring forward a request, so that 
he must busy himself with them, and then, in their negation, be- 
have like a maiden who stimulates her lover, but tries to appear 
as if she were keeping him off. At other times the negativism 
has a plainly erotic character, sometimes in the agreeable sense 
of a love-play, sometimes in an unpleasant sense, as the aversion 
to an attack, and often in both directions at once. 

Besides this outer negativism there is also an inner, which most 
frequently affects the will. The patient can not do exactly what 
he wishes to do. In the stage between thought and expression an 
inhibition, a contrary impulse, or a cross impulse can make the 
action impossible. So we see patients who rush to take a prof- 
fered bit of food, stop half way between plate and mouth, and 
finally refuse the morsel; with every other act the same results 
follow. If they start to shake hands : at any point the action may 
not only stop but the hand, as the result of a contrary impulse, 
may be placed behind the back. 

Often the patients frustrate the results of an act by other 
movements. They stretch the arm out in order to proffer the 
hand but flex the forearm and hand so that the hand can not be 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM $ 

taken; or on the request to show the tongue they put it out but 
turn away the head. In some of these cases of simultaneous 
obedience and disobedience one usually sees the external negativ- 
ism. But undoubtedly the phenomenon occurs as a pure will-nega- 
tivism. I have noticed it when the patient spontaneously occupies 
himself in something without outside invitation, for example 
in eating; mostly I have observed it in piano playing. They 
reach out for the stroke and strike down with the forearm, but 
towards the end of the movement dorsally flex the wrist to the 
maximum, so that the fingers do not reach the keys, or the 
patient turns the eyes to one side, in order to observe something, 
and at the same time turns the head to the other side (or the 
reverse). 

Cross impulses assert themselves, in that, instead of a willed 
or begun act another is carried out; the patient starts to take a 
spoon (to eat), the begun movement is changed however and 
he takes the fork, puts it in the bread basket or does something 
else equally pecuHar. These cases present all transitions to the 
apraxoid appearances of schizophrenia, which on their side 
again have different roots. 

Not infrequently negativism shows itself towards a task 
which has already been completed. The patients destroy what 
they have made. Sometimes as if in anger, sometimes as if from 
a free resolution, sometimes compulsively, resenting it in the 
doing. 

It is very difficult to get a clear idea of the subjective process 
of this will-negativism. Very few patients offer any explanation. 
It is certain, nevertheless, that some are aware of the disturbance, 
but not others, and that all possibilities actually occur with regard 
to the psychological point where this sets in. The patients sud- 



6 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

denly no longer will what they have just intended, or they sud- 
denly will the opposite ; their motive may come into consciousness 
or not; the goal idea becomes altered. This can, however, also 
remain the same, while the centrifugal impulse becomes disturbed 
somewhere in the tract z-m, which one can not conceive suffi- 
ciently long and complicated (compare for example Liepmann's 
researches on apraxia). Here the patients of course become 
more or less aware of the disturbance; but some bear it with 
the thoughtless indifference of schizophrenia, others feel it as 
a peculiarity which has befallen them, and conceive it, sometimes 
as something abnormal, sometimes as an influence from outside. 
Not at all seldom the negativistic impulse is transferred into hal- 
lucinations, which then, like other sensory falsifications, are in- 
terpreted subjectively in the most varied manner. A catatonic, 
for example, who will say something, hears his neighbor com- 
mand, " Hold your mouth." Another, who will €at, the voices 
forbid, or say, it would not be right; if he does not eat, it is again 
not right ; he asks despairingly, what in heaven's name he may do. 
To a third the voices always say the opposite of what he must do. 
A fourth receives hallucinatory commands for example, to write 
a letter ; as he is about to obey, the voices forbid him. He calls 
these hallucinations very significantly " plus and minus voices." 
There is probably little difference in principle when the negativism 
is transferred into delusions. H one requests such a patient to 
eat, stand up, walk, he does not do it. Afterwards he complains 
that he gets nothing to eat, that the physician compels him to lie 
in bed, forbids him to walk. The commonest negativistic delu- 
sion is in general that the patient believes it is forbidden him 
(under threats of danger or temporary or everlasting punish- 
ment) to do what he wishes. It is often shown from the change 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM / 

of the ideas and from the incorrect or artificial causal connection, 
that the delusion is in reality secondary, springs from the nega- 
tivistic attitude, and so only apparently accounts for the negativ- 
istic behavior. 

Intellectual negativism, negation of thought content, is the 
least known of all. Naturally it can only become perceptible 
as opposite thoughts ; it will hardly be possible to demonstrate the 
existence of a mere negativistic resistance against the contents 
of the thought. We find patients, who for each thought must 
think the opposite, or instead of a thought, imagine its negation 
or its opposite. An intelligent and philosophically accomplished 
catatonic said, "If one utters a thought, one sees always the 
opposite thought. That reinforces itself and extends so quickly 
that one does not know which was the first." Others complain 
that the thought comes to them "that is cold." when they touch 
something warm, and the like. One of our patients who was 
still able to work and was not confused had at times lost the 
f eeHng for positive and negative : she praised and found fault 
with her possessions, her husband, etc. in one breath, so that it 
was not possible to bring out what she really meant. 

If a patient retracts his own declaration, at times right after- 
wards in an agitated, pathetic tone, one can relate it just as 
well to negativism of the will as to that of the intelligence; he 
has come to the institution to get evidence — no, he wishes no 
evidence ; and so forth. 

In intellectual negativism the subjective side of the symptoms 
is also very variable. Many patients experience negativistic 
thoughts as compulsory, others are indiflferent, and again others 
do not notice it at all. This form of negativism is also often pro- 
jected as hallucinations; the patients then often hear the opposite 



8 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

of what they think or what they perceive in the outer world. It 
may also sometimes occur that the negativistic thought at its in- 
ception is transferred into compulsive actions so that the patients 
must say the opposite of what in reality they think. 

Occasionally intellectual negativism affects only the speech 
mechanism. The patients say the opposite of what they wish to 
say, especially they express against their will a negation, when in 
reality an affirmation was thought. " You are not a wretch," 
may be said to the physician, as a resume of a prolonged abuse 
for unjust confinement. One catatonic who was told to step up 
on a platform in the clinic protested energetically that she would 
not " go down there." Patients do not by any means always 
notice such mistakes, not even when one tries to call them to 
their attention. 

Probably it is a milder form of this same anomaly when 
the patient expresses the correct idea but in an unexpected nega- 
tive form: "that is not beautiful" for "that is ugly"; "that is 
not ugly " for " that is beautiful." In one case, which I have 
been able to observe for many years, such negative expressions in 
the mind of the patient became a unity before which another 
negation could be placed. She would say, " It is not not-ugly," in 
order to say that something was ugly. The " not-not-ugly " was 
used as one expression and used with a negative to express some- 
thing that was beautiful. It is conceivable, that the patient easily 
became confused and was no longer clear whether she affirmed 
or denied something; then held the listener responsible for puz- 
zling her. 

Negativism in the transference of words heard into the cor- 
responding thoughts has not yet been observed by me. It is cer- 
tainly not rare that the patients understand the opposite of what 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 9 

we say. That is, however, only the case when this opposite is 
identical with their delusions and wishes. The cases known to 
me are therefore ordinary examples of illusions of perception 
and memory. 

It is a very important, and yet an often overlooked character- 
istic of negativism, that it does not show itself uniformly, but at 
times is present and at times absent in accordance with the psy- 
chical constellation. It is quite usual that patients in their relations 
with other patients and with the attendants appear free from 
negativism, but on the contrary, they are very refractory to the 
physicians and their regulations. The reverse is not quite so 
common. To visitors also the conduct may be the contrary of 
the usual. Certain patients become suddenly negativistic when 
one touches a complex. Others, on the contrary, under the same 
circumstances, may lose their negativism for a time. 

What we have thus far designated as negativism must appear, 
after the mere description, to be a symptomatological collection, 
made up of very different things, and after it has been pointed out 
that the genesis of all these phenomena is not uniform, one may 
ask why all this is included in one conception. Not from respect 
for the teachings of the past, but because we are not yet able to 
distinguish between the various psychic processes which call forth 
negativism. The most varied manifestations may be derived 
from the same roots, and all the varieties mentioned may occur 
in the same patient in such mixtures and transitions that one will 
never be able clearly to separate them. 

It is self evident that inner negativism can assert itself out- 
wardly in negativistic acts. He who instead of " agreeable " 
thinks " disagreeable," must act wrongly, and will-negativism may 
lead to the same inaction or to contrary action as mere defense 



lO THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

to outside factors. On the other hand the repelling of outer in- 
fluences causes an inversion of the feeling tone, which evidences 
itself as inner negativism. The offering of food often causes 
disagreeable feelings, just because it comes from without; the 
declining then is obvious. But the disturbance should be sought 
in the negativistic vitiated emotional reaction rather than in the 
relation to the external world. This cannot be entirely denied 
because pararythmic reactions are not altogether infrequent in 
dementia prascox. 

Negativism is thus not an elementary symptom, but a collec- 
tive idea, comprising a number of symptoms, which are similar 
one to another, in that, in the different areas of psychic activity 
precisely that is left undone or the contrary is done which one 
would otherwise expect under the existing conditions. Nega- 
tivism most commonly involves a repelling of outside influences; 
it can express itself, however, as an inhibition or perversion of 
inner processes. Not even the repelling of outside influences is 
always founded on the same genesis, and in a given case, we shall 
see, several motives operate together, in order to bring about the 
repulsion. 

The idea of negativism is not always limited in this way. 
Kraepelin^ describes it under the title of weakened influence of 
the will and designates it as "the instinctive resistance against 
every outer influence of the will." This expresses itself, accord- 
ing to the author, in seclusion against outer impressions, in in- 
accessibility to every outer communication, in resistance to every 
demand, which can culminate in the systematic performance of 
exactly opposite actions. The latter is not always simply an 
exaggerated opposition, a " weakened influence of the will," but 

' Psychiatric, 8. Aufl., I, 380. Barth. Leipzig, 1909. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM II 

probably a suggestibility in a negative sense. Kraepelin does 
not mention inner negativism explicitly as belonging to nega- 
tivism : yet for him the blocking of the will is only a partial ex- 
pression of general negativism. The Kraepelinian idea of 
blocking is composed of two different things. What we mean 
by this name is a sudden arrest of psychic events that is often 
observed in thinking. It is one of the usual schizophrenic symp- 
toms and has its analogy in the arrest of thought in the healthy 
which is produced by some affect (terror, examination fright). 
Such blocking in thought and will may also occur in the absence 
of negativism, but negativistic disturbance of the will is condi- 
tioned by a contrary will, an " opposition." It is therefore fun- 
damentally different although the two causes may occasionally 
overlap as the negativism is also colored with affect. 

It appears to us that Kraepelin has laid too much weight on 
the seclusion from outer impressions. There are negativistic 
patients who are interested in everything, who tease others and 
generally seek stimuli from without. The schizophrenic repell- 
ing of outside influences ("Autismus," see below) does not 
necessarily express itself in a sensory declining, but only in the 
selection of the impressions and their elaboration. 

Hoche' defines negativism' as " the systematic resistance 
against external influencing of the will and also against impulses 
arising from within." Here we must replace the "systematic" 
that implies too much conscious activity by " instinctive " or 
" impulse-like." As Kraepelin rightly says, no intellectually under- 
stood motives play a part. Further " systematic " can not indicate 
a continuous type of conduct for the negativism does not appear 
at every opportunity, and it may be added, that the resistance 

•In: Binswanger und Siemerling, Lehrbuch der Psychiatric. Fischer, 
Jena, 1904. S. 258. 



12 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

may lead to the doing of the opposite. Furthermore, the defini- 
tion also ignores intellectual negativism. 

The behavior of the psyche of the patient towards the nega- 
tivistic symptoms is very variable. They may be fully united 
with the conscious psyche; the patients are then conscious, re- 
fuse voluntarily and then are irritable if one desires something 
of them, exactly like a well person, who wishes to know nothing 
of his environment. At the other extreme the negativistic ac- 
tivities emerge from the unconscious (as the voices and delu- 
sions) ; the patients are themselves surprised by them; they even 
defend themselves against them for some time; they wish to be 
agreeable, to follow orders, but are not able to do so. Contrary 
impulses and inhibitions of all sorts prevent the patients from 
doing what they have in view, so that commonly they believe in 
the influence of a strange force. All gradations intervene. So 
long as the patients are left alone they generally relate them- 
selves very well to the surroundings, and may resolve that they 
will not now react negativistically ; when the opportunity occurs, 
however, they are protesting and irritated ; they themselves won- 
der at such changes of mood and affect and can not discuss the 
matter. 

An attempt has been made to explain negativism by pro- 
ceeding from the motility, from muscular disturbances. Lund- 
borg* finds a similarity between the catatonic muscle phenomena 
and myotonia and thinks, that many patients in spite of wishing 
to, cannot move and therefore are apparently negativistic. He 
even brings the stereotypies, which lead to round-about imprac- 
ticable movements, into relation with this disturbance. This par- 

*Beitrag zur klin. Analyse des Negativisums bei Geisteskranken. 
Zentralblatt f. Nervenkrankh. und Psychiatric, 1902, S. 554. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 1 3 

allel with myotonia, shows that the author transposes the root of 
negativism to a centrifugal process, and thinks of this at least 
as peripheral; that the departure of the motor stimulus starts 
from the cortex, or possibly even in the muscles. I do not want 
to deny, that the outer picture of negativism may be produced 
through not being able to act, but not through a motor hindrance, 
but as the result of a psychic interference, like a child, who is 
bashful before a stranger, from whom he can not take a bonbon, 
even though anxious for a sweet. 

We have to do then with the inhibition of a purpose brought 
about by a contrary affect. This also occurs naturally in schizo- 
phrenia, but it is probably preferable not to call this phenomenon 
negativism in spite of the external resemblance. In spite of all 
my effort I have been unable to see a true motor disturbance in 
dementia prsecox either at the root of negativism or elsewhere. 
At all events there is nothing to observe in many cases with nega- 
tivism that one could even remotely explain as a motor symptom ; 
for many hyperkinetic patients are negativistic and vice versa the 
negativistic reactions frequently lead to very energetic and active 
muscular movements. The hypothesis, at best, can have only 
limited validity. 

R. Vogt^ discusses this theory but definitely localizes the 
difficulty of action in the motor centers. According to him there 
persists (as in the catatonic brain) a tendency to perseveration 
which manifests itself especially in the antagonists. In this way 
movements are made difficult, and this condition produces in the 
psyche a disinclination to movements in general. 

In view of the general disassociation of the schizophrenic 

psyche, the undoubtedly common tendency to perseveration might 

* Zur Psychophysiologic des Negativisums, Zentralblatt f. Nervenheillc 
u. Psychiatric, 1903, S. 85. 



14 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

be assumed to affect especially the antagonists in individual cases ; 
but no one has yet observed it. But, negativism never stands in 
a definite quantitative ratio to the degree of perseveration, and 
above all, those cases do not escape where there is no trace of 
perseveration, and in which the movements are in no way im- 
peded. So Vogt's view can not be right. 

Roller^ has already expressed similar ideas to those of Lund- 
borg and Vogt, as he likewise sought to derive the negativistic 
"will not" from a "can not" as the result of disturbances of 
innervation and besides conceived, that the contraction of the 
antagonists by way of their " re-innervation " called forth the will 
to contrary action. 

Alter'^ also considers negativism a motor phenomenon. His 
"primary negativism" springs from schizophrenic tonic rigidity. 
He assumes, as fundamental, a molecular alteration in the ner- 
vous system produced by toxins which makes possible sej unction 
in the paths of the protagonists. The exciting cause of the se- 
j unction is the attention, which easily inhibits what one wills. 
Through the sejunctive inhibition in the protagonist paths the 
impulse is directed to the antagonists. 

The existence of a catatonic tonus, as a true motor symptom 
is to me very questionable. My positive observations are limited 
to motor phenomena elicited by psychic factors and which are 
again removable by psychic means. On the other hand one often 
feels a mild resistance in the passive movements of schizophre- 
nics even when the patient willingly surrenders himself to all ex- 
periments. One cannot deduce negativism from this, as a strong 

* Motorische Storungen bei einfachem Irresein, Allgem. Zeitschrift f. 
Psychiatric, Bd. 42, S. i. 

'' Zur Genese einiger Symptome in katatonen Zustanden. Neurol. Cen- 
tralbl., 1904, S. 8. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM I 5 

resistance is precisely the result and not the cause of the psychic 
reluctance. 

Active negativism can not be interpreted anyhow by a round- 
about way through the antagonists. The innervation of the an- 
tagonists makes no retrogression from a progression, nor does it 
make a "no" from a spoken or written "yes." All of this re- 
quires quite special muscular coordinations. 

The theories which explain the unwillingness to act by a motor 
difficulty, and which deduce, from the innervation of the antag- 
onists, the idea and the will to an opposite action, are certainly 
wrong; in the first place, because a motor difficulty for the most 
part does not exist, and if it did, it would not be able to produce 
the motor phenomena of negativism ; in the second place, because 
innervation of the antagonists only exceptionally leads to a con- 
trary action. 

Wernicke* considers negativism and pseudo-flexibilitas as 
modifications of flexibilitas cerea, "which appear with retained 
possibility for any voluntary influence." The attempt at pas- 
sive movement is perceived within the cortex. At times it 
arouses the idea of the movement to be executed and renders 
easier the corresponding action of the will, at other times the 
thought of the impossibility of executing the movement arises, 
that is, to the idea of the movement to be executed is associated 
at the same time the inhibiting thought of an expected outlay of 
strength, which appears very great in the subjective estimation. 
The effect of the will thereby becomes reversed. Why at one 
time negative, and at another time positive ideas are awakened is 
not explained by this theory, just as it does not explain why a 
passive movement should ever arouse ideas of the impossibility 

* Psychiatric, Aufl. I, S. 453. 



l6 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

of executing the movement and of the expected outlay of force, 
and still less, how out of it can come the exhibition of strength 
of an often energetic resistance. The hypothesis forgets alto- 
gether, that only a small part of the negativistic phenomena is 
expressed as resistance to passive movements, while expressions 
of protest, contrary actions, and cross impulses are much com- 
moner. Also when one puts instead of " passive movements " 
"any demanded movement," this view is not rendered any more 
plausible. We would have to find occasionally the idea of im- 
practicability and demand for effort at the root of negativism. 
This I have never found. We see on the contrary aversion 
to mental or physical effort quite commonly without connection 
with negativistic expressions ; one symptom may be lacking, while 
the other is present, and where both are found together, one no- 
tices no parallelism in their intensity. 

For the comprehension of Wernicke, his further view, ac- 
cepted by others, is significant, that a partial negativism occurs in 
single muscle groups. Observation has never given me any 
proofs for such an assumption. I have learned to know negativ- 
ism only as a psychic phenomenon, with its expressions governed 
by ideas, not by anatomical conditions. Also I have been able, 
up to now, to localize the motor phenomena of schizophrenia only 
in ideas, although obliged to assume, that one of the predisposing 
causes lies outside the psychic area. (Perhaps something akin 
to brain torpor?). 

The psychic theories of negativism, for the most part, have no 
regard for the irregularity of its expressions. Thus the theory 
of Raggi" and Paulhan, who assume a contrast association, bring- 
ing out an action opposite to the one originally thought; or that 

' Psych. Kontrasterscheinungen bei einer Geisteskranken, Arch. ital. 
per le malatie nerv., Bd. 24, Ref. ; Allgem. Zeitschrift f. Psychiatric, 1887, 
S. 58. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 1/ 

of Sante de Sanctis,^" in whose opinion the spirit of negation in- 
herent in us outweighs the remnant of resistance of the ego. 
With such " explanations " the question is shelved behind a not 
very accurate circumlocution of the phenomena. Still less can 
we take up with the assumption of a " nolition,"^^ so long as 
this idea is not deduced from the elementary psychic manifesta- 
tions. 

In France and in part in Italy, negativistic phenomena, are 
frequently grouped with nihilistic ideas, and explained under 
the name of " ideas of negation." Naturally we cannot discuss 
with these authors, as the two symptoms are for us totally 
different. 

Anton^^ calls attention to the fact that many hebephrenics 
are pathologically suggestible and are more or less aware of it; 
they utilize therefore an elaborate refusal as a kind of psychic 
self regulation, as a protection against unpleasant influences. 
For this reason negativism makes a distinction between superior 
persons and such as are of equal or of lower station than the 
patient, in that it expresses itself more fully towards the 
former. Negativistic behavior, apart from schizophrenia is fre- 
quently noted also by us in genetic relationship with exaggerated 
susceptibility partly as the second side of the same affect disposi- 
tion which may express itself positively and negatively partly as 
an instinctive (more frequently than a conscious) protective 
measure. Precisely in schizophrenia, however, positive and neg- 
ative suggestibility do not by any means always run parallel, one 

" Negativismo vesanico e allucinazioni antagonistici, Bull, della soc. 
Lancisiana degli osped. di Roma, XVI, 96. Ref. Zeitschrift f. Psych, u. 
Physiol, der Sinnesorgan, Bd. 13, S. 397. 

"Centralbl. f. Nervenhkd. u. Ps., 1906, 622 (Dromard). 

" Nerven- und Geisteserkrankungen in der Zeit der Geschlechtsreife, 
Wiener klin. Wochenschrift, 1904, S. 1 161. 



1 8 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

with another, in course and stren^h. We believe that such fac- 
tors essentially cooperate in the origin of negativism, but that 
the symptom, however, must have still other and indeed more 
important roots. 

Schiile^^ assumes a " contrary direction of the will," which is 
conditioned through anxious helplessness ; it expresses itself first 
in simple, then in contrary (active) negativism. This "anxious 
helplessness " is too commonly wanting in negativistic patients 
for us to deduce the phenomenon from it. Yet there is some- 
thing true also in this conception, in so far as lack of understand- 
ing of the environment usually leads to negativistic reactions, 

Gross^* refers first to the helplessness as causing the " affect 
state of negation." This alone, or in conjunction with inhibition, 
produces a form of negativism. According to him, there is, how- 
ever, in addition a " true catatonic (psychomotor) negativism," 
that is, " a complex of phenomena, which form the expression of 
a series of psychophysical processes separated from the con- 
tinuity of the ego, in no way related with the psychic processes of 
the conscious personality, and therefore inaccessible to any intro- 
spective after contemplation." There is thirdly a "psychic" or 
" total " negativism, which is compounded of the two first forms. 
The conception of the second form can not be correct. While 
it is true that schizophrenic psychisms can functionate fully disso- 
ciated from the ego-complex, this does not answer the question 
why precisely such phenomena become negativistic. In reality 
such psychic automatisms can be negativistic or not, in the same 

" A. Zeitschrift, Bd. 58, S. 226. 

" Die Affektlage der Ablehunng. Monatsschrift fur Psychiatric und 
Neurologic, 1902, Bd. XII, S. 359. Beitrag zur Pathologic dcs Nega- 
tivisums. Psychiatrisch-neurol. Wochenschrift, 1903, V. Jahrg., S. 269. — Zur 
Differential-Diagnostik negativistischer Phanomcne. Psychiatr.-Neurol. 
Wochenschrift, 1904, Bd. VI, S. 345. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 1 9 

manner as conscious functioning processes. On the other hand 
the idea of an " affect state of negation " contains an element of 
truth although it is not a genetic explanation of negativism. One 
can ascribe to all these negation processes a common component, 
the negation, and the negation, as with all conflicts, is associated 
with an affect, so that the term cannot be entirely repudiated as a 
circumlocution of the affective volitionistic part of the nega- 
tivism. However, the idea is not at all clear, and keeping in 
mind the different moods in which negativistic symptoms appear, 
the identity of the affective phenomena, grouped together as the 
" affect of negation," must be doubted. 

Kleist^^ also assumes a peculiar " feeling," which he parallels 
with the " feelings of anxiety, of anger, of joy," thus, according 
to our terminology, an affect is made the foundation of the nega- 
tivism. In some cases it is expressed as a painful sensation of 
weakness in the heart, in others as an unmotived anxiety. Why 
it appears, the author leaves unexplained, but that is precisely 
what we wish to know. I must again raise the objection that I 
have not been able to make out a " peculiar characteristic feel- 
ing" that was the same in each case of negativism. 

On close examination the same grounds will be found as 
causes of pathological negativism as for the negative attitude in 
health. First one repulses when one does not wish to be dis- 
turbed. This is also regularly the case in schizophrenic nega- 
tivism. All these patients are highly " autistic,"" that is, turned 

" Weitere Untersuchungen von Geisteskranken mit psychomotorischen 
Storiingen. Leipzig, Klinkhardt, 1909, S. 97 f. 

" By autistic I understand practically what Freud (not however Have- 
lock Ellis) means by autoerotism. I think it well, however, to avoid the 
latter expression, as it is misunderstood by all those not very familiar with 
Freud's writing. I have discussed this at length in the chapter on 
Schizophrenia in Aschaffenburg's Hand-Bookof Psychiatry. The symptom 
of ambivalence to be mentioned later in the text is also discussed in this 
book. 



20 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

away from reality; they have retired into a dream life, or at least 
the essential part of their dissociated ego lives in a world of 
subjective ideas and wishes, so that to them reality can bring only 
interruptions. Many patients state this, with full consciousness, 
to be the reason for their behavior. They wish to remain undis- 
turbed within themselves, and so it is apt to vex them extremely 
if the attendant merely comes into the room to bring food. Their 
stereotypies, their peculiar attitudes and other quirks have special 
relation to their complexes : for them they are often the realized 
fulfillment of their wishes; they are not only symbols of their 
happiness, as one might approximately conceive from the stand- 
point of health, but they are the essential part of happiness itself. 
They have, therefore, grounds enough to defend themselves 
against anything likely to rob them of this treasure. 

It is self evident that autism does not express itself merely 
in centripetal relations to the outer world. There are two reasons 
for this : The patient who wishes to isolate himself from reality 
must permit the environment to act upon him as little as possible, 
but he must also not wish to influence it actively himself. For 
two reasons : By doing so he would become distracted from 
within and obliged to heed the external world so as to be able 
to act upon it; furthermore, through the action himself he would 
create new sensory stimuli and other relations with reality. The 
autistic and negativistic patients are therefore mostly inactive ;^'^ 
they have actively as well as passively narrowed relations with 
the outer world. 

" Under special circumstances this seclusion may be overcome as in 
the acute hyperkinesias, in which the movements result from an impulse, 
and in paranoids, who, while the autism is not fully complete, are sensible 
of the interference with their wishes, and translate them into delusions of 
persecution and react accordingly. In both cases there is a much nar- 
rowed relation to the outer world. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 21 

But the autistic patients have, not alone, a positive reason for 
busying themselves undisturbed with their own ideas where they 
see their wishes fulfilled. The imagined happiness is not abso- 
lute. It is destroyed not only through the influences of the outer 
world and the conception of reality, but in its place appears much 
oftener at once under such circumstances, the sensation of the 
opposite, of the, in reality, unfulfilled wish. All these patients 
have a life wound, which is split off from the ego as well as may 
be, and hidden by an opposite conception. For that reason they 
must defend themselves agamst any contact with their complex; 
and, as in the splitup thought process of the schizophrenic, every- 
thing, so to say, may have its association to the complex, so every- 
thing may be painful to them that comes from the outside. This 
genesis of negativistic phenomena may often be established 
through observation or direct experiment when touching of the 
complexes calls forth the negativism, where it would not other- 
wise appear. 

With this conduct the patients exaggerate and caricature only 
one of the usual manifestations of the normal. It is a general 
experience, that questions, which relate to complexes, are at once 
answered in the negative, even when the persons wish to be open, 
and afterwards speak of it without dissembling. For there exists 
an instinctive tendency to conceal the complex. Normal persons, 
likewise see to it that their life's wound is not touched upon, and 
they also often have in misfortune the tendency, to withdraw 
within themselves, because by contact with others there are 
so many things that root up the pains, by associations with the 
complex. Even in consequence of bodily pains, which can not 
be relieved, we often see negativistic conduct, especially in chil- 
dren, who under such circumstances draw back and become re- 



2 2 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

pellant in the same manner as our patients, sometimes towards 
all influences from the outer world, sometimes only under special 
conditions. 

Among children we see still other grounds for negativistic 
conduct : they often do not understand what is expected of them 
and turn against the unknown through general obstinacy, for ex- 
ample, during a medical examination, or in being photographed. 
We observe the same thing in imbeciles, the deaf and dumb and 
partially deaf, the dream state in epileptics, and in timid or ob- 
stinate animals. Schizophrenics also are frequently no longer 
able to understand the environment, and must become, in the 
same manner, cross and repelling, although in the course of the 
disease, the general blind resistance which under normal condi- 
tions is to their interest, becomes a detriment. 

From the standpoint of the patients the environment more- 
over frequently appears not only not understandable but directly 
inimical ; at best it does not enter into their needs. We incar- 
cerate them in an institution, rob them of their personal rights; 
they do not wish to concern themselves about the world, and we 
wish to force them to ; they have ideas of grandeur which are not 
recognized ; they wish to love without being able to command an 
object; they are persecuted and find no protection, but instead, 
misunderstanding and refusals. 

In the institution the physicians and attendants become the 
incarnations of such disappointments, while the other patients 
sympathize with the patient mostly not at all or only superfi- 
cially, and at any rate stimulate the complexes much less than 
the officers of the institution. The relatives are sometimes drawn 
into the complexes, sometimes not. The difference in the effect 
in the negativism towards different persons is thus easily com- 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 23 

prehended. It is just as intelligible that negativism will be called 
out or increased by opposition from outside, but is dispersed 
through the greatest possible nonchalance. 

The affectivity of schizophrenia contains, furthermore, an 
additional root of negativism. In the beginning of the disease 
especially we can often observe a more marked touchiness of the 
affect, and there is much to indicate the existence of, in the later 
course, a pathological irritability. Under such circumstances we 
see, in patients who are not schizophrenics ( for example, in neu- 
rasthenics) as in schizophrenics who are still capable of social 
relations, a drawing into themselves, the greatest possible avoid- 
ance of all stimuli and a reaction to influences which differs from 
negativism quantitatively only. Naturally the negativism orig- 
inating from other sources produces on its side an analogous un- 
derlying affective state, so that irritability and negativism to- 
gether form a vicious circle. 

Increased difficulty of action and thought is a further root 
of negativism which is clear in some cases. There are many 
different reasons for this, some of which we probably do not yet 
know. I have not yet been able to establish, as mentioned, a 
specific motor disturbance. On the contrary there are phenomena 
resembling brain pressure. True action is moreover impeded by 
the disturbed associations, most commonly, however, we find in 
the schizophrenics a peculiar inability to direct their thoughts. 
" It thinks " in the patients. The flow of thought is automatic, 
independent of the will; often it is felt as a most painfully fati- 
guing compulsion ; often also the pressure of thought is a matter 
of indifference as long as he is left to himself. So soon, however, 
as he is forced by stimulation from without to change the direc- 
tion of his thoughts, highly distressing feelings arise in both 
events, which enforce an attitude of repelling. 



24 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

That the negativistic repelling very often bears the outspoken 
stamp of the erotic must be due to a root of the negativism being 
in the sexuality. This is very easily understandable. The sex- 
uality has normally a strong negativistic component; it shows 
itself clearest in the opposition of the female against the sexual 
approach, which we find in animals and also in man, where the 
sexual act is desired.^^ We know that there is no case of schizo- 
phrenia in whose complexes sexuality does not play a prominent 
role, and very often the repelling is founded in sexual delusions, 
the patients believing themselves loved or violated. 

In general, negativism has a close relationship to delusions and 
hallucinations. These can naturally not lead to a true negativism 
but to conduct, that can not at all be differentiated directly from 
negativism, and as delusions and negativism, for the most part, 
appear side by side, it is wholly impossible, to separate the part 
played by one factor from that played by the other. The diffi- 
culty is increased through the fact that delusions and especially 
hallucinations are often the sequelae, or better, the expression of 
negativism ; the voices do not necessarily express the negativistic 
state of feeling but may correspond to another affect. Indeed 
very frequently the delusion is stated by the patient afterwards 
falsely as the reason for the negativistic conduct. A young 
woman, with whom during a paroxysm, one could establish 
fairly good communication in spite of the negativism, declared 
afterward, however, that she thought some one tried to hypnotize 
her and then offer violence to her, on that account she had always 
done the opposite of what was desired of her. 

"This opposition lies apparently at the bottom of the aversion of the 
cultured to think or speak of sexual things. I certainly do not underrate 
the role of artificial convenience ; this convenience, however, which leads to 
so much disadvantage and nonsense, must be grounded in our nature, 
otherwise it would not have developed. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 2$ 

Up to this point the description has dealt with passive nega- 
tivism which opposes itself against any demand coming from out- 
side. The resistance leads naturally to active defense, abuse, and 
to blows, but the doing of the opposite of what is demanded re- 
quires a special motivation which in part suggests itself. He who 
will not open the mouth on request, voluntarily clenches his jaws; 
he who answers to the request to go forward by walking back- 
wards, is best guarded against a sudden surprise which might in- 
sist upon the carrying out of the command ; he who will not sit 
in a certain place indicated sits better in another ; he who will not 
eat his own portion must take another's or go hungry. In short, 
the opposite action is in most cases so nearby, so self evident, it 
so emphasizes the denial and provides such a good position of 
defence, that it is very apt to be used instinctively by both man 
and animals. 

Not rarely, however, the contrary action so far overshoots 
the mark that the hitherto utilized motive for its explanation is 
no longer sufficient. Thus a patient, who wishes to go to bed and 
has undressed, receiving a careless command from the attendant 
to go to bed, at once begins to put his clothes on again. By error 
a patient is given cabbage, among other things, on her plate, when 
it is well known that she does not like it. As she usually gets 
no dessert, unless she has finished, she is told she need not eat 
the cabbage ; now she eats only the cabbage and leaves the other 
better liked things on her plate. This same catatonic plays the 
piano ; as soon as she notices that she is listened to with pleasure, 
she stops ; she looks curiously at everything unusual, but at once 
turns away, however, if anyone pays any attention to her. When 
she hears an accidental remark : " Now she is doing that," she 
stops at once, or does the opposite. — Here belong also the for- 



26 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

bidden actions. There are patients who will do nothing except 
what is forbidden them, so that one can make use of this peculiar- 
ity. — Or the patient will not carry out an action until it is too 
late or is no longer possible. So it is quite usual that they first 
draw back the hand that they should reach out but at once ex- 
tend it as soon as one turns away from them, or that they give 
no answer so long as one busies himself with them, but begin 
to speak when one turns to other patients or when one is about 
to leave the room. It may also happen that schizophrenics will 
speak for others but are dumb when asked questions themselves 
(whether indifferent or important is irrelevant), or when they 
might have wishes of their own to express. 

In these cases, in which the negativism leads to actions, of 
course those explanations no longer suffice which explain it with 
the need for rest or the difficulty of the procedure. The inimical 
relation of the environment could rather be considered as the 
root for such conduct, but it is absent in many such cases and 
shows no parallelism with negativism where it is present. There- 
fore, there must be still other causes of negativism. 

The tendency to generalization of single symptoms, always 
demonstrable in schizophrenia, first suggests itself. Stereotypies, 
resistances, etc., which are well founded in some occasion, read- 
ily expand and become fixed, or at least come to light on many 
occasions where they are out of place. 

A schizophrenic may be imagined as so working up his eva- 
sions, that he carries them out when the situation does not de- 
mand it and in a manner which is in contradiction with his orig- 
inal (unconscious) object. I do not know how often negativistic 
symptoms are to be explained in this manner, but when one 
closely observes the individual patients, one gets the impression 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 2/ 

that the tendency to generalization does not commonly lead to 
exactly such conduct. 

Ambitendency and ambivalency are of by far greater signifi- 
cance. Both of these two related characteristics, especially the 
latter, are immeasurably increased in schizophrenia. 

I formerly, rather one sidedly, applied the term negative sug- 
gestibility^® to the psychological fact that a definite tendency to 
contrary or opposite action is combined with every impulse, 
whether coming from within or without. I would now prefer 
to designate the whole idea as " ambitendency." Even in health 
the negative constituent often gets the upper hand; so soon as 
one has decided on something, the feeling comes that one had 
better have done the opposite ; people with weak will are there- 
fore prevented from acting. In the territory of the unconscious 
the opposite impulse often runs counter to our wish. More 
especially one wishes to be potent on his wedding night, and ex- 
actly then most commonly, a transitory impotence occurs. When 
for any reason the menses are especially awaited, then particu- 
larly they fail, etc. 

But there are exceptions. As a rule the normal person allows 
the pro and con to act together, as the physicist works with two 
forces in opposite directions in such a way that the resultant is 
governed by the stronger impulse. But, however, as there are 
always two tendencies, it needs only a small disturbance of their 
balanced relations, in order to bring out one of them, and this can 
as well be the negative as the positive one. 

In schizophrenia, however, several such disturbances are 
present. It lies in the character of the disease, that the inter- 
association of ideas is loosened : each thought, each tendency can 

" Psych.-Neurol. Wochenschrift, 1904, VI Bd., Nr. 27/28. 



28 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

exist for itself, without influencing the others and being influ- 
enced by the others. Thus a catatonic seats herself at a strange 
table, cordially assures those standing about: "have no anxiety, 
I am going to take nothing," serves herself, however, at the same 
time with sweets and chews with her mouth full. She, or rather, 
something in her, knows that she should not help herself ; that it 
is disagreeable to those about for her to eat at the table prepared 
for the guests ; she therefore sooths the onlookers, and imagines 
herself, as not taking anything, but another component of her split 
psyche longs for the good things and lays to. The two psychisms, 
which in health would be united in an action of choice, go along 
here side by side without in the least influencing each other. 

While in the above observation the two impulses have become 
simultaneously active it is also possible for only one impulse to 
become active at a given moment, giving the other free play to be 
operative later on. Each goal by itself may dominate the patient 
for a certain length of time making him the sport of his different 
impulses. Whether he acts in a positive or negative sense is a 
matter of accident more or less. Also an already carried out 
action can be annulled; as when a patient destroys a fully com- 
pleted piece of work. The negative and positive tendencies can 
also change very quickly, even during the carrying out of an 
action. " Not seldom we observe a vacillation in the strength 
of the positive and negative tendencies ; sometimes one, sometimes 
the other, gains the supremacy. There comes a sudden stand-still 
and then, just as suddenly, a continuation of the original move- 
ment; it continues by fits and starts and becomes angular and 
awkward."2« 

Kraepelin explains this by the absence of the guiding influ- 

" Kraepelin, Psychiatric, Achte Auflage, I, 373. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 29 

ence of permanent endeavors and volitional tendencies upon 
actions. A better expression would be to say that the goal is 
constantly changing. Gross seeks the pathogeny in the loss of the 
" highest psychic function." The idea of the latter is very vague. 
The " synthesis " of the different trends, an expression, which is 
used by the French for a quite similar conception, is rather a 
general characteristic of the normal psyche; naturally, like many 
others, it can become relatively easily disturbed, because it is 
proportionally complicated. It is not lacking, however, in chil- 
dren, idiots, or animals, only, corresponding to the greater sim- 
plicity of such psyches, less developed. It thus becomes difficult 
to designate this association of different correlated ideas and 
trends, which suffers first in schizophrenia, in a unity as the high- 
est psychic function. What we observe is just the splitting, the 
independence of single psychisms, and we will indeed do well, 
in this obscure territory not to go beyond the observations. 

In schizophrenia the stimulus from the outside produces quite 
as easily, negative and positive reactions : The negative sug- 
gestibility is pathologically increased. The building up of neg- 
ative and positive suggestibility goes along, for the most part, 
hand in hand. Children, senile dements, and other sorts of 
affective people are under certain circumstances very easily sug- 
gestible; they are, however, quite as often stubborn and negativis- 
tic against outer influences. Some authors have long maintained 
that hysterics suffer from excessive suggestibility, while others 
deny suggestibility from without; and refer it all to autosugges- 
tion. In reality both peculiarities exist side by side; they are 
only different sides of one and the same element of character. 
Certainly, the preponderance of protestations, as already men- 
tioned, has, often besides, the significance of a sort of protection 
against the exaggerated suggestibility. 



30 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

In schizophrenia especially, Kraepelin has quite correctly 
brought negativism into relation with abnormal suggestibility, 
which expresses itself in command automatism. We often see 
in the same patient negativism and command automatism side 
by side, indeed the one may pass into the other. Schizophrenics, 
like children, swing from one extreme to the other. It must be 
added that these two characteristics do not always occur together. 
The relation, even in schizophrenia, is complicated in such a man- 
ner as to resist reduction to a simple formula. Schizophrenics, 
nevertheless, as a whole, in spite of their autistic seclusion from 
outside, are found to be remarkably suggestible by close examina- 
tion. Fellow patients who are the ringleaders of a ward find the 
schizophrenics an easy butt, and for the spiritus loci there is no 
more delicate reagent for the local color of an institution than the 
apparently isolated mass of its schizophrenics. 

Kleist^^ denies the connection of " negative suggestibility " 
with negativism. This author has the decided merit of having 
enlarged upon Wernicke's ideas, of carrying them to their end 
and presenting them clearly. It is thus a duty to come to an 
understanding with him. In the first place he cavils at the con- 
ception that inhibition should occur in the field of motility as the 
result of the contrary conception which arises with each idea, con- 
stituting a peculiar disturbance in the course of ideation for 
which brain pathology has no analogy. Here comes out very 
strongly the difiference in methods of investigation. Brain pa- 
thology analogies have proved themselves so unfruitful in psychi- 
atry,^- that to begin with we do not care whether we find thera 

" Kleist, Weitere Untersuchungen an Geisteskranken mit psychomo- 
torischen Storungen. Leipzig, Klinkhardt, 1909, S. 97 f. 

^ Cerebral pathology and localization ideas have led so extraordinarily 
capable an observer and fruitful thinker as Wernicke into sterile by-ways. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 3 1 

or not. On the contrary we seek analogies in the thinking of the 
healthy, and then this so characteristic inhibition shows itself to 
be neither peculiar nor strange. So among the normal many 
conclusions and actions are stopped in this manner either tem- 
porarily or continuously. 

Kleist further opposes, that to many ideas there are no con- 
trary ideas, and that a negativistic patient who is requested to 
pick out the red wools certainly would not choose the green. Here 
the author confuses the intellectual contrary idea with the affec- 
tive — the voluntary. We are only considering the latter. Kleist 
moreover fails to consider that I expressly assume different ge- 
netic forms of negativism and designate negative suggestibility as 
only one of several roots. 

Ambivalence. — By ambivalence is to be understood the spe- 
cific schizophrenic characteristic, to accompany identical ideas 
or concepts at the same time with positive as well as negative feel- 
ings (affective ambivalence), to will and not to will at the same 
time the identical action? (ambivalence of the will) and to think 
the same thoughts at once negatively and positively (intellectual 
ambivalence). 

In the case of an idea which arouses both negative and posi- 
tive feelings the difference is not always sharply appreciated even 
in health, or otherwise expressed, when a normal person loves 
something or somebody on account of one quality but hates them 
on account of another, the result is not an entirely unitary feeling 
tone, either the positive, or the negative outweighing at times.^^ 
The ultimate conclusions are not necessarily drawn by the split 
psyche of the schizophrenic. The mentally sick wife loves her 
husband on account of his good qualities and hates him at the 

*^ A normal ambivalent group of ideas is represented by the sexual, 
especially in women, as stated previously. 



32 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

same time on account of his bad ones, and her attitude towards 
each side is as though the other did not exist. 

Ambivalence of the will or voluntary ambivalence is the 
natural outcome of affective ambivalence. Intellectual ambiva- 
lence needs special consideration. It is of course in close asso- 
ciation with affective ambivalence in many judgments but not in 
all. Even from the purely intellectual point of view each thought 
is in many ways most closely akin to its opposite; not only that 
the closest association to "white" is "black": each judgment 
contains the negation of its opposite, and there would be no sense 
in thinking it unless the contrary had entered into consideration : 
I can not think and say : " the sky is blue," unless the contrary, 
that it may not be blue, is, so to say, in the air.^* Censure of a 
picture lies psychologically much nearer praise of the picture 
than any other thought. Children frequently use the same ex- 
pressions for both positive and negative ideas, for example, tii 
tu for Tiire zu (door to) for open and close the door, also " zu- 
letzt" (last) for "zuerst" (first), and later, when they first 
begin purely in play to judge, they often do not care at all how 
they express the same.'^ 

With the confused schizophrenics the distinction is often com- 
pletely blotted out. Affective motives also probably cooperate, 
as in the above mentioned patient, who at the same time cen- 
sured and praised her husband; but it is probably a purely 
intellectual fault when a catatonic who after having answered 

^* " Each idea demands, as it were, a contrary idea as its natural com- 
plement." Wreschner, Reprodnktion und Assoziation von Vorstellungen, 
Zeitschr. fiir Psych, u. Phys. der. Sinnes-0., Erganzungsband 3, 07/9, 
S. 595- 

^ Compare also the latin " religio," that was used in both a good and 
a bad sense, as a blessing and as a curse. Also see van Ginnecken (Principe 
de linguistique psychologique, Leipzig, 1907), who goes rather too far. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 33 

his wife's friendly letter, with an unmotived farewell letter, said, 
in answer to expostulations: "I could have just as well written 
another letter, good day or farewell are just the same " (dire bon- 
jour ou dire adieu). So thesis and antithesis in our patients 
often become so similar as to become confused or even identified 
one with another. 

Ambitendency and ambivalency in themselves bring about only 
an equalization of correct thoughts and conflicts with their oppo- 
sites. In negativism, however, these opposites actually gain the 
ascendant. There are two known reasons for this: In the first 
place this predilection is certainly often merely apparent. Even 
the negativistic produces correct thoughts and actions. When, 
however, among a thousand psychisms in our day only a single 
one is negativistic it is conspicuous, the probability would be that 
in the equalization of tendency and antitendency there would be 
five hundred false to five hundred correct reactions, a proportion 
which would imply severe negativistic anomalies. 

Furthermore the previously mentioned " contradictions with 
reality," especially autism, take care that the contrary action is 
favored as much as possible. 

Outer negativism is therefore, in the first place, due to a 
number of factors, which place the patient in opposition to the 
outer world; the effect of this contrariness can become so exten- 
sive because the schizophrenic ambitendency and ambivalency 
furnish a good soil for it, and above all, remove what in the nor- 
mal opposes perverse actions. 

Ambitendency and ambivalency make inner negativism also 
somewhat comprehensible to us in some degree, which would not 
be explainable through other factors which cause negation. When, 



34 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

as in will-negativism, each impulse is opposed by a contrary^* im- 
pulse, and when the psyche is so split that each of these two 
tendencies can independently assert itself so that a compromise 
between them is impossible or is made very difficult, then the 
antitendency will often manifest itself instead of the tendency. 
It has not been positively demonstrated that it is just this anti- 
tendency which asserts itself with especial frequency. It is, how- 
ever, probable that such cases occur. They would in some de- 
gree be intelligible through the inner disruption in which such 
patients find themselves. They are not pleased with anything, 
nothing gives them any satisfaction, so it is comprehensible that 
they seek something else ; and that " something else " is very often 
the opposite. 

I believe, however, that there exists besides an unknown fac- 
tor which gives a special weight to the contrary tendency, not 
only because the observation of negativistic schizophrenics some- 
times appears to point that way, but also because auto-suggestions 
in the normal are so frequently negative; the menstrual period 
arrives when it is certainly not expected and vice versa. This 
factor requires further study. 

The cross impulses have very different significance. A part 
of them are, of course, negativistic. One will not do the desired 
and so in some cases does the opposite; in others only something 
else. The apraxiform approximate acts often have the character 
of acts in emotional confusion under which circumstances the 
normal make all sorts of errors. Most commonly the cross im- 
pulses probably are the result of the specific schizophrenic train 
of thought in which all at once the nearby association becomes the 

** The contrary impulse often consists in the not carrying out of the 
original intention. From our view point to do something and not to do 
it is a contrast, just as to do something and to do the opposite. 



THE THEORY OF SCHIZOPHRENIC NEGATIVISM 35 

principle thing ; the thought is at once cut off and there is a new 
one of unknown genesis or at least of insufficient connection with 
the preceding; or suddenly a quite abrupt thought, an hallucina- 
tion, an automatic impulse to movement, suddenly arises out of 
unconscious complexes. It is sufficient only to hint at these 
things which are self evident to one who knows dementia prsecox. 

Intellectual negativism resembles volitional negativism very 
much. When an idea stimulates its opposite and the thought 
becomes split and unclear, so that criticism is difficult, the antith- 
esis is apt to acquire undue weight, and under certain circum- 
stances replace the thesis. The latter especially because the 
patients, with their changed feeling and thinking, are often actu- 
ally compelled to see the thing in an unusual way. Nevertheless, 
cases like the one previously mentioned, in which each thought 
compelled the thinking of a contrary thought, give cause for the 
conjecture, that here preference escapes us as a factor that leads 
to the contrary thought. Also the dream of the normal, in which 
many an idea is represented by its opposite, appears to me to point 
to an active predilection for the negative. Perhaps also the 
mechanism of wit, which often replaces one thing by its opposite, 
has a point of contact with intellectual negativism. 

It has also occurred to us that inner negativism, especially the 
intellectual, might express itself in experiments in negative or 
contrast associations. This conjecture has not been established 
by proof; we have only seen a striking tendency to contrast asso- 
ciation in two patients, and precisely these were not negativistic. 

R. Voght^'^ on the basis of the views of Lipps, propounds a 

hypothesis which might explain, in hysterics, how an idea may 

inhibit precisely the closely related and therefore other to-be- 

" Die hyst. Dissoziat. im Lichte der Lehre von der Energie-Absorption. 
Zentralbl. f. Nervenheilk. u. Psychiatric, 1906, S. 249. 



36 THE THEORY OF SCHIZOPHRENIC NEGATIVISM 

anticipated concepts. I believe the supposed identification of 
transfer of energy and association therein set forth is too vision- 
ary to warrant discussion. 

Inner negativism is much rarer in both its forms than outer 
negativism. This is easily understood after we have seen how 
much outer negativism is favored by the disturbed relations to 
the environment, which are constantly present, but favor will- 
negativism only slightly, and intellectual negativism even less. 
Negativistic phenomena can not so easily originate, of course, ex- 
clusively upon the basis of ambitendency and ambivalency, the 
predisposing factors of negativism. 



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